Risk Factors and Incidence of Acute Kidney Injury in Patients Receiving CAR-T Cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy is a major advancement in the personalized treatment of hematological malignancies, and it is being explored in the fight against solid organ tumors. Cytokine release syndrome (CRS) and neurotoxicity are well-documented as potential side effects of the treatment. However, less is known about the incidence of acute kidney injury (AKI) in patients receiving CAR T-cell therapy, or the risk factors for AKI in this patient population.

According to a systematic review recently published in Kidney International Reports, the incidence of acute kidney injury (AKI) in patients receiving CAR T-cell therapy ranges from 5% to 33%.

“The mechanism of AKI in patients with CAR-T cell therapy is not completely understood. However, it is proposed that AKI could be secondary to inflammation associated with cytokine release, potentially leading to acute tubular injury,” wrote the authors, led by Swetha R. Kanduri of the Department of Medicine at Ochsner Medical Center in New Orleans, Louisiana.

The authors conducted a systematic review of the literature through May 2020, then performed a meta-analysis of data regarding AKI among patients receiving CAR T-cell therapy. The researchers sought to uncover a correlation between severity of CRS and the incidence of AKI requiring renal replacement therapy (AKI-RRT).

The search yielded 32 articles involving 3,376 patients. The incidence of AKI among all patients was 19%, but most patients experienced only mild AKI. The incidence of AKI-RRT was 4%. The pooled incidence of CRS was 75%. Analysis indicated a strong correlation between AKI-RRT and severe CRS.

Interestingly, the study found a higher incidence of AKI and AKI-RRT in the pediatric population than in older adults. Although the reasons behind that finding are unclear, the author hypothesized that it could be related to higher doses, excessive tumor burden, higher blast count, and immune immaturity.

“As AKI-RRT is associated with higher mortality and morbidity, it would be helpful to undertake additional preventive strategies … in patients at high risk for severe CRS to mitigate the risk of AKI,” the authors suggested.